Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality fo...

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Published in:International journal of nursing studies Vol. 78; pp. 10 - 15
Main Authors: Ball, Jane E., Bruyneel, Luk, Aiken, Linda H., Sermeus, Walter, Sloane, Douglas M., Rafferty, Anne Marie, Lindqvist, Rikard, Tishelman, Carol, Griffiths, Peter
Format: Journal Article
Language:English
Published: England Elsevier Ltd 01.02.2018
Elsevier Limited
Subjects:
Bayesian analysis
Care left undone
Clinical outcomes
Cross-sectional studies
Cross-sectional study
Death & dying
Hospital
Hospitalization
Hospitals
Mediation
Medical personnel
Missed care
Mortality
Mortality rates
Nurse staffing
Nurses
Nursing
Nursing education
Patient safety
Patients
Polls & surveys
Post-surgical
Staffing
Surgery
Surgical outcomes
Post-surgical
Care left undone
Mortality
Nurse staffing
Patient safety
Hospital
Cross-sectional study
Mediation
Missed care
ISSN:0020-7489, 1873-491X, 1873-491X
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Summary:Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. Data from the RN4CAST study (2009–2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses’ staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse’s workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031–1.106) and 16% (OR 1.159 95% CI 1.039–1.294) increase in the odds of a patient dying within 30days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an ‘early warning’ indicator of higher risk for poor patient outcomes.
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Ball & Bruyneel contributed equally to this article.
RN4CAST Consortium: Walter Sermeus (Director), Koen Van den Heede, Luk Bruyneel, Emmanuel Lesaffre (Belgium, Catholic University Leuven); Linda Aiken (Co-Director), Herbert Smith, Douglas Sloane (USA, University of Pennsylvania); Anne Marie Rafferty (UK, King’s College London), Simon Jones (UK, University of Surrey) Jane Ball, Peter Griffths (UK, University of Southampton); Juha Kinnunen, Anneli Ensio, Virpi Jylhä (Finland, University of Eastern Finland); Reinhard Busse, Britta Zander, Miriam Blümel (Germany, Berlin University of Technology); John Mantas, Marianna Diomidous (Greece, University of Athens); Anne Scott, Anne Matthews, Anthony Staines (Ireland, Dublin City University); Ingeborg Strømseng Sjetne (Norwegian Knowledge Centre for the Health Services) Inger Margrethe Holter (Norwegian Nurses Organization); Tomasz Brzostek, Maria Kózka, Piotr Brzyski (Poland, Jagiellonian University Collegium Medicum); Teresa Moreno-Casbas, Carmen Fuentelsaz-Gallego, Esther Gonzalez-María, Teresa Gomez-Garcia (Spain, Institute of Health Carlos III); Carol Tishelman, Rikard Lindqvist, Lisa Smeds-Alenius (Sweden, Karolinska Institutet); Sabina De Geest, Maria Schubert, René Schwendimann; Dietmar Ausserhofer (Switzerland, Basel University); Theo van Achterberg, Maud Heinen, (Netherlands, Radboud University Nijmegen Medical Centre), Lisette Schoonhoven (Netherlands & England, University of Southampton).
ISSN:0020-7489
1873-491X
1873-491X
DOI:10.1016/j.ijnurstu.2017.08.004